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General NPI Number Information
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NPI Number | 1528438884
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Entity Type | Organization
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Legal Business Name | MCLEAN AMBULATORY SURGERY, LLC
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 7601 LEWINSVILLE RD SUITE 440
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City | MC LEAN
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State | VA
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Zip | 22102-2814
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Country | US
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Telephone | 703-663-1440
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Fax | 703-752-1105
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Provider Business Mailing Address
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Address Line | 7601 LEWINSVILLE RD SUITE 440
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City | MCLEAN
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State | VA
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Zip | 22102-2834
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Country | US
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Telephone | 703-663-1440
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Fax | 703-752-1105
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Authorized Official
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Title or Position | A/R & OPERATIONS MANAGER
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Name | DARASINH PHOUMMITHONE MAYARD
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Credential | AUTHORIZED OFFICIAL
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Telephone | 703-395-6410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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